Lic 701 2026

1. Click ‘Get Form’ to open the lic 701 in the editor.
2. Begin with Part A, where a parent or guardian must provide consent. Fill in the child's name and birth date, followed by the name of the child care center and its operating hours.
3. In Part A, ensure that the parent or guardian signs and dates the form to authorize the release of medical information.
4. Proceed to Part B for the physician's report. The physician should complete this section by noting any health concerns such as allergies, vision issues, and developmental considerations.
5. Fill out the immunization history section accurately, detailing each vaccine received along with corresponding dates.
6. Lastly, review any TB risk factors present and have the physician sign and date at the bottom of Part B.

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